Dress to impress in the ICU

Dressing in "traditional" medical attire may help physicians in the intensive care unit (ICU) to get relationships with their patients' families off to a good start, research suggests.

Although less than a third of participants in the study expressed a preference for ICU physicians to wear customary healthcare attire, when asked to select the "best" physician from a selection of photographs, most opted for one wearing a white coat, or scrubs.

"These results suggest that while families may not express preferences for how physicians dress, there may be subconscious associations with well-recognized physician uniforms including white coats and scrubs," say lead researcher Henry Stelfox (University of Calgary, Alberta, Canada) and team.

"Given the importance of effective communication in the ICU, physicians may want to consider that their attire could influence family rapport, trust, and confidence," they write in JAMA Internal Medicine.

Unlike in primary care, patients do not generally have a pre-existing relationship with their physician, notes the team. So establishing trust in a short time is crucial, and the critical condition of many ICU patients necessitates involvement of their families.

The study involved 337 relatives of ICU patients, who were invited to participate a median of 3 days after the patients had entered the ICU. They were predominantly women (68%), White (78%), and educated to college or university level (60%).

When asked to consider 10 factors relating to physician appearance, the family members attached most importance to wearing an easy-to-read name tag, with 77% of the participants considering this important. This was followed by neat grooming (65%) and professional dress (59%).

Only a small proportion of respondents considered gender, race, and age important, and just 32% thought that a physician should be wearing a white coat.

However, when asked to rate photographs of medical professionals, 52% of families opted for a physician wearing a white coat as the best overall, with 24% picking a doctor in scrubs, 13% selecting a physician in a suit, and 11% one in casual attire.

Physicians in white coats were also top rated in terms of being the most knowledgeable (about 55%), and the most honest (45%). Physicians in scrubs were rated as the most competent by about 45% of participants, slightly but not significantly ahead of physicians in white coats (about 40%).

These findings are contrary to the theory that patients have less preference for traditional medical attire in acute care settings, note Stelfox et al. They suggest that the traditional uniforms associated with the medical profession help patients and families to identify their healthcare providers.

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